摘要
目的 探索血清泛素羧基末端水解酶-L1(UCH-L1)、组织非特异性碱性磷酸酶(TNAP)在老年脓毒症相关性脑病(SAE)患者中的表达及临床意义.方法 选取2019 年3 月—2021 年3 月空军军医大学空军第 986 医院老年病科诊治老年脓毒症患者 177 例为研究对象,根据是否合并SAE分为SAE组(n =80)和非SAE组(n =97).根据28d内的生存情况,将SAE组分为生存亚组(n =48)和死亡亚组(n =32).采用酶联免疫吸附实验检测血清UCH-L1、TNAP的表达;指标之间的相关性采用Pearson相关分析;多因素Logistic回归分析影响SAE患者死亡预后的因素;受试者工作特征曲线分析血清UCH-L1、TNAP及联合对SAE患者死亡预后的评估价值.结果 SAE组血清UCH-L1、TNAP、C反应蛋白、降钙素原、神经元特异性烯醇化酶(NSE)、SOFA评分、APACHEⅡ评分均高于非SAE组(t/P =14.268/<0.001,18.872/<0.001,4.607/<0.001,11.589/<0.001,7.689/<0.001,7.572/<0.001,8.177/<0.001).SAE患者血清UCH-L1、TNAP水平与降钙素原、C反应蛋白、NSE、SOFA评分、APACHEⅡ评分呈明显正相关(r/P =0.547/<0.001,0.661/<0.001,0.602/<0.001,0.514/<0.001,0.498/<0.001;0.477/<0.001,0.529/<0.001,0.632/<0.001,0.607/<0.001,0.474/<0.001).死亡亚组SAE患者血清降钙素原、C反应蛋白、NSE、UCH-L1、TNAP、APACHE Ⅱ评分、SOFA评分均高于生存亚组(t/P =7.586/<0.001,3.311/0.001,6.735/<0.001,13.569/<0.001,11.592/<0.001,5.205/<0.001,12.180/<0.001);血清NSE、UCH-L1、TNAP、APACHE Ⅱ评分及SOFA评分升高是影响SAE患者死亡预后的独立危险因素[OR(95%CI)=1.868(1.323～2.638),1.840(1.193～2.838),1.578(1.122～2.219),1.659(1.119～2.576),1.606(1.105～2.336)];血清UCH-L1、TNAP及二者联合评估SAE患者死亡预后的AUC分别为 0.848、0.813、0.904,二者联合优于各自单独评估价值(Z/P =3.864/0.003、4.270/<0.001).结论 SAE患者血清UCH-L1、TNAP表达升高,两者与病情严重程度有关,血清UCH-L1、TNAP联合对老年SAE患者死亡预后具有较高的评估价值.
Abstract
Objective To explore the expression and clinical significance of serum ubiquitin carboxyl terminal hydrolase-L1(UCH-L1)and tissue non-specific alkaline phosphatase(TNAP)in elderly patients with sepsis associated en-cephalopathy(SAE).Methods One hundred and seventy-seven elderly patients with sepsis treated in the Department of Geriatrology at the Air Force 986th Hospital of the Air Force Medical University from March 2019 to March 2021 were se-lected as the research subjects.They were divided into SAE group(n=80)and non-SAE group(n=97)based on whether they were combined with SAE.According to the survival status within 28 days,the SAE group was divided into survival subgroup(n=48)and death subgroup(n=32).Enzyme linked immunosorbent assay was used to detect the expression of serum UCH-L1 and TNAP.The correlation between indicators was analyzed using Pearson correlation analysis.Multivariate logistic regression analysis of factors affecting the prognosis of death in SAE patients.The evaluation value of serum UCH-L1,TNAP,and their combination in predicting the mortality prognosis of SAE patients by analyzing the working characteris-tic curve of the subjects.Results Serum UCH-L1,TNAP,C-reactive protein,procalcitonin,neuron specific enolase(NSE),SOFA score and APACHE Ⅱscore in SAE group were higher than those in non SAE group(t/P=14.268/<0.001,18.872/<0.001,4.607/<0.001,11.589/<0.001,7.689/<0.001,7.572/<0.001,8.177/<0.001).The serum UCH-L1 and TNAP levels in SAE patients were significantly positively correlated with procalcitonin,C-reactive protein,NSE,SOFA score,and APACHE Ⅱ score(r/P=0.547/<0.001,0.661/<0.001,0.602/<0.001,0.514/<0.001,0.498/<0.001;0.477/<0.001,0.529/<0.001,0.632/<0.001,0.607/<0.001,0.474/<0.001).The serum procalcitonin,C-reactive protein,NSE,UCH-L1,TNAP,APACHE Ⅱ score,and SOFA score of SAE patients in the death subgroup were higher than those in the survival subgroup(t/P=7.586/<0.001,3.311/0.001,6.735/<0.001,13.569/<0.001,11.592/<0.001,5.205/<0.001,12.180/<0.001).Elevated serum NSE,UCH-L1,TNAP,APACHE Ⅱ scores,and SOFA scores are independent risk factors affecting the prognosis of SAE patients[OR(95％CI)= 1.868(1.323-2.638),1.840(1.193-2.838),1.578(1.122-2.219),1.659(1.119-2.576),1.606(1.105-2.336)].The AUC of serum UCH-L1,TNAP,and their combined evaluation of mortality prognosis in SAE patients were 0.848,0.813,and 0.904,respec-tively.The combination of the two was superior to their respective individual evaluation values(Z/P=3.864/0.003,4.270/<0.001).Conclusion The expression of serum UCH-L1 and TNAP is elevated in SAE patients,which is related to the severi-ty of the condition.The combination of serum UCH-L1 and TNAP has high evaluation value for the prognosis of death in elderly SAE patients.
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